Paper 17 - Royal United Hospital Bath NHS Trust
Paper 17 - Royal United Hospital Bath NHS Trust
Paper 17 - Royal United Hospital Bath NHS Trust
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Report to: Public <strong>Trust</strong> Board Agenda item: <strong>17</strong><br />
Date of Meeting: 29 May 2013<br />
Title of Report:<br />
Status:<br />
Board Sponsor:<br />
Author:<br />
Appendices<br />
Chief Executive’s Report<br />
For Information<br />
James Scott, Chief Executive<br />
James Scott, Chief Executive<br />
1. Purpose of Report (Including link to objectives)<br />
The purpose of the Chief Executive‟s Report is to highlight key developments within<br />
the <strong>Trust</strong> which have taken place since the last Board meeting.<br />
2. Summary of Key Issues for Discussion<br />
2.1 Operational Performance<br />
The Urgent Care Task and Finish Group between providers and commissioners at<br />
Director level, has now engendered some momentum to addressing the demand and<br />
flow issues across the system. This will be critical preparation for the next winter in <strong>17</strong><br />
weeks time. The Intensive Support Team is shortly scheduled to undertake a whole<br />
system diagnostic. In addition to this, it has been formally agreed to enter into a<br />
simulation event with all stakeholders present, in order to better collectively<br />
understand the escalation triggers and associated actions needed. April performance<br />
is clearly disappointing and actions are being accelerated wherever possible. Weekly<br />
performance towards the latter part of the month and in to May are encouraging.<br />
2.2 Spring to Green Week<br />
Spring to Green week took place between 13 th – 18 th May 2013 and was designed to<br />
generate energy for change by doing things differently to support patient flow and<br />
improve patient experience, safety and staff morale. The scope was inpatient wards<br />
and Emergency Department supported by all the departments that serve these areas<br />
e.g. site team, discharge liaison team, therapies, information technology, facilities,<br />
MEMS, diagnostics, pharmacy etc. The underlining principle was „Right Bed, Right<br />
Patient‟ and staff supported in enabling a safe discharge to create the capacity and<br />
consequently improve patient flow. Ward Liaison Officers (non-clinical staff) were<br />
placed on the wards and were responsible for escalating issues with patient flow,<br />
patient experience (e.g. environmental issues) or affecting staffs ability to deliver<br />
excellent patient care.<br />
In terms of performance during the week, the expected outcomes were;<br />
Green escalation status<br />
Minimum 25 patients discharged and 50 declared discharges by noon.<br />
50% increase in direct admits to Ambulatory Care, Surgical Assessment Unit<br />
and 100% direct admits to the Acute Stroke Unit<br />
Emergency Department patients reviewed in 60 mins by senior clinician<br />
Maximum of 15 medical outliers<br />
Medical Day Case Unit and Cardiac Day Case unit out of escalation<br />
Reduction in staff moves<br />
Author: Helen Perkins, Senior EA to Chairman & Chief Executive<br />
Date: 20 th April 2013<br />
Document Approved by: James Scott, Chief Executive<br />
Version: One<br />
Agenda Item: <strong>17</strong> Page 1 of 5
0 electives cancelled due to bed capacity<br />
Reduction in concerns/incidents raised by Staff<br />
Reduction in number of complaints<br />
All of the above were achieved and some exceeded expectation, e.g. by Wednesday<br />
there were no outliers, every patient was placed in the right bed. For the first time in<br />
three months there were no new patient complaints. All wards were out of escalation<br />
on Monday morning and Medical Assessment Unit/Surgical Assessment Unit changed<br />
beds for trolley's to enable direct admits to once again go direct to wards, by-passing<br />
the Emergency Department. The biggest achievement was the 'can do' attitude of<br />
staff and the team effort that went into the week. The initiative would not have been so<br />
successful if it was not for the Ward Liaison and Departmental Liaison Officers that<br />
worked together to achieve the common purpose. The success of the event has also<br />
been recognised by the national Intensive Support Team who have commended the<br />
way the event was set up and run throughout the week.<br />
A report is being compiled on the outputs and lessons learnt from the event and will<br />
be brought to the June Board.<br />
2.3 Cancer Care Campaign<br />
Sir James and Lady Deirdre Dyson have generously donated £4m to the development<br />
of a pioneering new Cancer Centre at the <strong>Trust</strong>. The Forever Friends Appeal<br />
announced last year that it was starting its largest ever fundraising campaign, aiming<br />
to raise a minimum £5.5m towards the £20.5m cancer project, over the next three to<br />
four years. Following this donation the Appeal have almost all their initial minimum<br />
target secured and are able to extend their target for the Campaign, due to the<br />
excellent public support, to raise up to a further £3m. These additional facilities which<br />
will maximise the impact of the Centre‟s clinical care, are likely to include space for<br />
complementary therapies and educational activity linked to survivorship, a dedicated<br />
area for teenager and younger Adults, the use of art, pastoral gardens, the provision<br />
of state-of-the-art medical equipment and increased dedicated research facilities.<br />
2.4 <strong>NHS</strong> Complaints Review<br />
The <strong>Trust</strong> was contacted in mid-April by the Complaints Review Team at the<br />
Department of Health with a request from Ann Clwyd MP to visit the RUH to discuss<br />
the complaints handling process. Following the publication of the Francis report the<br />
government has asked Ann Clwyd to head up a review of complaints management<br />
across the <strong>NHS</strong> and as part of that process a number of visits are being carried out<br />
across the country to various organisations.<br />
The RUH were delighted to welcome Ann and her team on 22 nd April 2013 where they<br />
met with members of the Executive Team and the Patient Experience Team. In<br />
addition to this there were two ward visits, to Respiratory and Forrester Brown wards<br />
where the team were able to speak with the Ward Sister and Charge Nurse about the<br />
way that complaints and concerns are managed. Further discussions were had over<br />
lunch where a number of clinical staff met the review team. The <strong>Trust</strong> responded to a<br />
number of questions that the review team had and the information will be used as part<br />
of a final report being produced by the team.<br />
Author : Helen Perkins, Senior EA to Chairman & Chief Executive<br />
Date: 20 th April 2013<br />
Document Approved by: James Scott, Chief Executive<br />
Version: 1<br />
Agenda Item: <strong>17</strong> Page 2 of 5
2.5 Dr Foster Global Comparators Programme<br />
Dr Carol Peden, Associate Medical Director for Quality Improvement and Dr Louise<br />
Shaw, Consultant Stroke Physician, represented the RUH at the Dr Foster Global<br />
Comparators meeting in New York in April.<br />
The Global Comparators programme brings together more than 30 hospitals from<br />
around the world to share their data on HSMR, length of stay and readmission rates<br />
using the Dr Foster database and methodology. The aim of the programme is to drive<br />
improvement through collaboration and learning from high performers, within the<br />
domains of clinical effectiveness, patient satisfaction and cost. The RUH is very<br />
committed to the project with Dr Peden Chairing the Executive Board. The project has<br />
a number of “goal” work-streams, which are stroke, gastrointestinal (GI) surgery, heart<br />
failure and orthopaedics and trauma. Dr Shaw participated in the Stroke goal team<br />
meetings and Dr Peden in the GI surgery group. The general part of the meeting saw<br />
discussion of how hospitals worldwide analyse their mortality data. There was also a<br />
session on comparisons between the different health care systems with, for example,<br />
the UK having a significantly lower number of hospital beds per head of population<br />
than any of the other participating countries.<br />
The programme has had a relatively slow start with comparisons of data between the<br />
different health care systems proving much more difficult than anticipated because of<br />
the very diverse nature of the way hospitals are run around the world. The database<br />
provides a huge wealth of data and numerous quality improvement and research<br />
projects are now underway. The RUH is analysing the GI emergency surgery data,<br />
which fits with our interest in emergency general surgery. We are also putting together<br />
a project with the Business School at <strong>Bath</strong> University to learn from the international<br />
data on how to deliver a 24 hour a day, 7 day a week health service.<br />
2.6 Institute for Healthcare Improvement Visit<br />
The Institute for Healthcare Improvement (IHI) Fellows visited the <strong>Trust</strong> on 12 th and<br />
15 th April 2013 as part of their retreat before the International and US Quality<br />
Improvement Forum.<br />
Present at the visit, which was organised by Dr Carol Peden, Associate Medical<br />
Director for Quality Improvement and IHI Fellow, were Maureen Bisognano, Chief<br />
Executive of IHI, Professor Don Goldmann, Senior Harvard Professor and Head of<br />
Research at IHI and Jeff Sellberg, Chief Operating Officer of IHI. The programme for<br />
discussion during the retreat was varied with significant time spent on the Francis<br />
report. Professor Don Berwick, Emeritus President of IHI, is advising David Cameron<br />
on how to create a harm free <strong>NHS</strong>, and the Fellows spent a lot of time debating what<br />
advice they planned to give to Professor Berwick.<br />
During the course of their visit to the <strong>Trust</strong>, the Fellows met with members of the<br />
Executive Team as well as visiting the “Art at the Heart” team, Qulturum and Dyson<br />
Centre for Neonatal Care where they learnt about the quality and safety projects ongoing<br />
at the RUH. The Fellows felt the retreat was incredibly successful and would<br />
like to repeat the opportunity again in the future.<br />
Author : Helen Perkins, Senior EA to Chairman & Chief Executive<br />
Date: 20 th April 2013<br />
Document Approved by: James Scott, Chief Executive<br />
Version: 1<br />
Agenda Item: <strong>17</strong> Page 3 of 5
2.7 2013 Military and Civilian Health Partnership Awards<br />
Dr Richard Graham, Consultant Radiologist and Joint Clinical Lead for Radiology, has<br />
been shortlisted for a 2013 Military and Civilian Health Partnership Award in the<br />
Healthcare Reservist of the Year category which aims to promote and publicly<br />
recognise the efforts of health professionals from the public, private and voluntary<br />
sector(s) across the UK in providing care to service personnel, veterans and their<br />
families.<br />
Richard has recently returned from a tour of duty in Afghanistan where he was<br />
Consultant Radiologist and Radiology Clinical Director at the military hospital at Camp<br />
Bastion. He was an integral member of the trauma team delivering immediate imaging<br />
to severely injured troops and also providing general radiology to personnel working<br />
for the international security assistance force. This was Richard's second tour of duty<br />
in two and half years.<br />
Richard is also head of the <strong>Royal</strong> Naval Reserve Medical branch and leads the<br />
doctors and nurses nationally. He has also been involved in the strategy of the<br />
expansion of the reserve forces under the government's Future Reserves 2020<br />
project.<br />
2.8 <strong>NHS</strong> Foundation <strong>Trust</strong> Update<br />
As at <strong>17</strong> th May 2013, 6,244 public members have signed up to support the <strong>Trust</strong>‟s<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> application.<br />
Our tenth Caring for You Event took place on 20 th May 2013; over 70 members<br />
attended the event to find out more about Stroke and the work that we do here at the<br />
RUH. Dr Louise Shaw and her team lead the interactive session; guests received two<br />
detailed presentations about Stroke and were then invited to have some refreshments<br />
and talk to the medical experts in more detail whilst having a look at some of the<br />
“information stations” that the department had created. The Stroke Association came<br />
along, and there were different information stands including Stroke research, speech<br />
and language therapy, brain scans and carotid imaging.<br />
2.9 Executive Director Appointments<br />
Following an interview process on 12 th April 2013, Helen Blanchard has been<br />
appointed to the post of Director of Nursing. Helen is currently Chief Nursing Officer at<br />
Worcestershire Acute <strong>Hospital</strong>s <strong>NHS</strong> <strong>Trust</strong> and will join the <strong>Trust</strong> on 27 th August 2013.<br />
Lynn Vaughan, Director of Human Resources, will be retiring from the RUH at the end<br />
of July. Lynn has been HR Director since July 2004 and has led the strategic<br />
response to workforce issues during a challenging period of the <strong>Trust</strong>‟s development.<br />
Krystyna Ruszkiewicz will join the <strong>Trust</strong> as Interim HR Director from Tuesday, 16th<br />
July 2013. Krystyna has extensive experience of working in similar posts within the<br />
<strong>NHS</strong>, having previously been Director of HR at the <strong>Royal</strong> Marsden and also at the<br />
Chelsea and Westminster <strong>Hospital</strong>.<br />
Author : Helen Perkins, Senior EA to Chairman & Chief Executive<br />
Date: 20 th April 2013<br />
Document Approved by: James Scott, Chief Executive<br />
Version: 1<br />
Agenda Item: <strong>17</strong> Page 4 of 5
Interviews for the substantive Director of Human Resources will be held on 2nd July<br />
2013.<br />
Following an interview process on 29 th April 2013, Julie Hill has been appointed as<br />
<strong>Trust</strong> Board Secretary. Jill is currently in the same position at Tavistock and Portman<br />
<strong>NHS</strong> Foundation <strong>Trust</strong> and will join the RUH on 1 st July 2013. Julie has also<br />
previously worked in both central Government and local Councils.<br />
2.10 Consultant Appointments<br />
Dr Lynn Diskin was appointed as a Consultant in Paediatrics with a particular<br />
responsibility for children with Diabetes on 8 th May 2013. Dr Diskin will join the <strong>Trust</strong><br />
from Musgrove Park <strong>Hospital</strong>, Taunton where she is currently employed as a<br />
Specialist Registrar in General Paediatrics. Dr Diskin‟s start date is to be confirmed.<br />
3. Recommendations (Note, Approve, Discuss etc)<br />
The Board is asked to note the report.<br />
4. Care Quality Commission Outcomes (which apply)<br />
Not applicable<br />
5. Legal / Regulatory Implications (<strong>NHS</strong>LA / Value for Money Conclusion etc)<br />
Not applicable<br />
6. <strong>NHS</strong> Constitution<br />
None identified<br />
7. Risk (Threats or opportunities link to risk on register etc)<br />
Strategic and environmental risks are considered by the Board on a regular basis and<br />
key items are reported through this report.<br />
8. Resources Implications (Financial / staffing)<br />
Not applicable<br />
9. Equality and Diversity<br />
Not applicable<br />
10. Communication<br />
Not applicable<br />
11. References to previous reports<br />
The Chief Executive submits a report to every <strong>Trust</strong> Board meeting.<br />
12. Freedom of Information<br />
Public<br />
Author : Helen Perkins, Senior EA to Chairman & Chief Executive<br />
Date: 20 th April 2013<br />
Document Approved by: James Scott, Chief Executive<br />
Version: 1<br />
Agenda Item: <strong>17</strong> Page 5 of 5